Acute interstitial pneumonitis during chemotherapy for haematological malignancy.

Fourteen adult patients with haematological malignancies (eight non-Hodgkin's lymphoma, one multiple myeloma, one chronic lymphocytic leukaemia, two acute lymphoblastic leukaemia and two acute myeloid leukaemia) developed acute interstitial pneumonitis (IP) during the course of chemotherapy. All patients manifested high fever over 38 degrees C, bilateral diffuse pulmonary interstitial infiltrates in the chest radiograph and severe hypoxia without hypercapnia in the arterial blood gas analysis. Pathogenic microorganisms were not detected in repeated examinations in any patient.

Elevated levels of soluble interleukin-2 receptor in serum of patients with hematological or non-hematological malignancies.

We measured the levels of soluble interleukin-2 receptor (sIL-2R) in the serum of 53 patients with hematological malignancies (14 with acute leukemia, 10 myeloproliferative disorders, 21 non-Hodgkin's lymphoma and 8 multiple myeloma), 40 with non-hematological solid malignancies (24 with lung cancer, 11 digestive system cancer and 5 other cancers) and 95 healthy subjects as a control using an enzyme-linked immunosorbent assay. Both hematological and non-hematological neoplasms showed significantly higher sIL-2R levels than normal subjects (p<0.01).

Hemostatic abnormalities following bone marrow transplantation.

Hemostatic abnormalities in 26 patients following bone marrow transplantation (BMT) were examined. In the event-free survival group, the plasma levels of antithrombin (AT) and protein C (PC) were significantly decreased 1 and 2 weeks after BMT, and the plasma levels of thrombomodulin (TM) and tissue plasminogen activator-plasminogen activator inhibitor-1 complex (tPA-PAI-I complex) were significantly increased from 4 weeks to 13 weeks after BMT. Excepting AT, there was no significant difference in hemostatic parameters before BMT among the event-free survival, 6-month survival, and death within 6 months groups.

Effect of direct infusion of antifungal agent on invasive pulmonary aspergillosis in a patient with acute leukemia.

Invasive pulmonary aspergillosis is a serious problem in the treatment of patients with acute leukemia. A 52-year-old woman with acute myeloid leukemia developed invasive pulmonary aspergillosis during remission induction chemotherapy. Initially, we treated her with a continuous intravenous drip infusion of amphotericin B, together with itraconazole, given orally.

[Aggressive transformation and extramedullary tumor formation in IgA-lambda multiple myeloma].

A 52-year-old woman complained of lower back pain and gluteal pain in April 1997, and was found to have anemia, hypercalcemia and renal disorder. In September of the same year, she was diagnosed as having IgA-lambda myeloma (stage IIIA). VMMD-IFN therapy was started in November, 1997, and this resulted in improvement of the M-protein level, and relief of the pain in the lower back and gluteal region.

HTLV-1 unrelated adult T-cell leukemia/lymphoma with unique phenotype and karyotype.

We describe a unique case of adult T-cell leukemia/lymphoma (ATL). The patient had typical clinicohematological features as ATL, but showed a lack of antibody to human T-cell leukemia virus type-1 (HTLV-1) and was negative for HTLV-1 proviral DNA in the peripheral mononuclear cells by means of polymerase chain reaction. The phenotype of tumor cells revealed CD7+, CD5+, CD2+, CD3+, WT31-, TcR delta 1-, CD4-, CD8-, CD25-, and the karyotype showed a 5q-, t(12;18).

Clinical importance of interleukin-2 receptor alpha-chain expression in acute leukemia. The Japan Cooperative Group of Leukemia/Lymphoma.

To clarify the clinical importance of interleukin-2 (IL-2) receptor (IL-2R) expression in acute leukemia, we examined 517 adult patients with acute leukemia and CML blast crisis (CML-BC). IL-2R alpha was expressed in 42/311 AML, 5/11 acute unclassified leukemia, 24/116 pre-B ALL, 2/32 T-ALL, and 27/47 CML-BC, while IL-2R beta was expressed only in 2 T-ALL. Expression of IL-2R alpha was closely associated with that of different lineage markers, CD11b, CD34, and Ph1+ abnormality.

Hemostatic abnormalities and increased vascular endothelial cell markers in patients with red cell fragmentation syndrome induced by mitomycin C.

We examined red cell fragmentation syndrome (RCFS) induced by mitomycin C (MMC) (13 patients), by thrombotic thrombocytopenic purpura (TTP) (17 patients), and by disseminated intravascular coagulation (DIC) (15 patients). Plasma cytokine levels were increased in the TTP and DIC patients, but not in those whose RCFS was induced by MMC, suggesting that the activation of the immune system plays an important role in the pathogenesis of RCFS due to TTP and DIC but did not in RCFS due to MMC. Plasma thrombomodulin, tissue type plasminogen activator, and plasminogen activator inhibitor-I levels were increased in all RCFS patients, suggesting that RCFS, whether MMC induced, or due to TTP or DIC, might be associated with vascular endothelial cell injury.

[Myelofibrosis complicated by T-cell lymphoma followed by leukemic transformation].

A 37-year-old man was admitted because of pancytopenia with leukoerythroblastosis and anisocytosis in January 1986. Bone marrow aspiration resulted in a dry tap and biopsy showed marked myelofibrosis. Three months after admission, generalized lymph node swelling and multiple skin tumors were recognized.

[Acute promyelocytic leukemia following ulcerative colitis].

We report a case of acute promyelocytic leukemia (APL) following ulcerative colitis (UC). A 23-year-old man was diagnosed as UC in January 1991 and had been treated with salazosulfapyridine and prednisolone with good effect. In September 1993, he developed bleeding tendency and a diagnosis of APL with disseminated intravascular coagulation was made based on the results of bone marrow aspiration and coagulation profile.

Acute myelomonocytic leukemia in a patient with multiple myeloma: evidence for different clonal origin.

A case of 77-year-old female with multiple myeloma (IgG-k) developed acute myelomonocytic leukemia (AMMoL) following a myelodysplastic stage after chemotherapy with melphalancyclophosphamide combinations for 6 years. The leukemic blast cells expressed both myeloid antigens (CD11b, CD13, CD14, CD15, CD33 and CD34) and T/B lymphoid antigens (CD2, CD4, CD22 and PCA1). Cytogenetic analysis revealed a chromosome deletion -7.

Quadruple cancers in a human T-cell leukemia virus type 1 carrier.

Human T-cell leukemia virus type 1 (HTLV-1) infection is considered to contribute to the risk of malignancies other than adult T-cell leukemia. We report a 64-year-old male HTLV-1 carrier who developed quadruple malignancies such as cancer of the urinary bladder, skin, larynx and liver.

CD7, CD4 and myeloid antigen-positive acute lymphoblastic leukemia.

We report a case of acute lymphoblastic leukemia (ALL, FAB-L2) with unique cellular characteristics. Leukemic cells were negative for various cytochemical stainings except acid phosphatase. Immunophenotypic studies revealed CD7+, CD4+, CD8-, CD2+, CD3-, CD13+, CD25+, CD33+ and CD34+.

Pathogenesis of fever of unknown origin in patients with acute leukemia and granulocytopenia.

Interleukin-1 (IL-1) is an endogenous pyrogen produced by blood monocytes or tissue macrophages in response to infection. Since hepatic macrophages (Kupffer cells) make up more than 90% of tissue macrophages and have a possibility of remaining intact after cytotoxic chemotherapy, they may be the major producers of IL-1 in infection during prolonged periods of severe monocytopenia in leukemic patients having modern chemotherapy treatment. Hence, the majority of febrile episodes probably due to infection in patients with acute leukemia and granulocytopenia may be caused by an inflammatory response mediated by IL-1 derived from the Kupffer cells in the liver sinuses.

[Cimetidine-induced aplastic anemia complicated with nonbacterial thrombotic endocarditis and cerebral infarction].

A 72-year-old woman had been given cimetidine 400mg/day for her gastritis since June 17, 1987. On August 8, she developed oral bleeding. Peripheral blood showed pancytopenia (WBC 1,900/microliters, RBC 208 x 10(4)/microliters, Plt 0.